Abstract：Objective To investigate the value of neutrophil to lymphocyte ratio (NLR) in early grading diagnosis of neonatal hypoxic ischemic encephalopathy (HIE). Methods A total of 134 cases were collected in Lanzhou University Second Hospital and were divided into three groups:the mild HIE group (n=42),the moderate and severe HIE group (n=36),and the normal control group (n=56).It was included neonatal general information,birth situation,blood cell count on 1st day,3rd and 7th day,and calculating NLR and platelet to lymphocyte ratio (PLR).The cranial magnetic resonance imaging (MRI) was scaned in the time of 1st week after birth.Univariate factor analysis,receiver operating characteristic curve (ROC curve) and Kappa consistency analysis were used to determine the NLR value. Results Univariate analysis showed that white blood cells count,neutrophils count and NLR levels on 1st day and 3rd day were the risk factors in the moderate and severe HIE group.Compared with the normal controls,NLR levels on 1st day of the moderate and severe HIE patients increased significantly (5.55±1.88 vs 2.63±0.91,P<0.05),relatively,that of the mild HIE patients increased slightly (2.71±0.92 vs 2.63±0.91,P>0.05).The levels of NLR in the moderate and severe HIE group was significantly higher than that of the mild HIE group (5.55±1.88 vs 2.71±0.92,P<0.05);ROC curve showed the efficiency of NLR on 1st day(area under the curve up to 0.959) was the highest with sensitivity of 93.3%,specificity of 81.0% and the optimal cut-off value was 3.43;Kappa analysis showed that the Results of NLR were consistent with that of cranial MRI in 1st week after birth. Conclusion NLR has a certain predictive value for the early grading diagnosis of HIE after asphyxia.